Health 2.0 a-Go-Go: A Revolution By Any Other Name Would Smell as Sweet

During the standard what’re-you-doing-this-week segment of a Sunday barbecue, I told a neighbor who works in the real world that I was “going to the Health 2.0 Conference in San Francisco,” a sort of random zeitgeist check on a phrase I use so often at work I don’t really remember what it means.

“Don’t know what the hell that is,” he said, his jaw tightening. “But I’m sure it’ll be better than health 1.0. Anything would be better than the mess we have now!”

Wow, I thought; he just set the world outdoor speed record for eruption-of-health-care-anger – and in the midst of the Olympic season for same.

My friend’s outburst was a weird if completely uninformed endorsement of the Health 2.0 conference booting up at San Francisco’s Design Center Concourse in the morning.

But in an era when smoldering resentment and unvarnished rage have come to pass for political dissent (i.e., when a simple proposal to clean up the worst messes in the health insurance marketplace is decried as a “governmental takeover”), my left-leaning neighbor is in accidental agreement with everyone – left or right – just itching to CTRL-ALT-DELETE the entire health care system, for no more intelligible reason than the whole thing sucks.

He also happens, if accidentally, to be very much in agreement with many of us health care 2.0 types – left, right, or strawberry – flocking in exponentially increasing numbers to the Health 2.0 Conference for three years running. Forget the hype, the promise of orgiastic punditry, or the funhouse atmosphere created by the event’s irrepressible creator and THCB editor Matt Holt. Regardless of your politics or business agenda, we are at Health 2.0 because we know that, as a society, economy, health system, whatever – we can do better than health 1.0, should do better, must do better.

So what exactly is health 2.0? Isn’t it really just a younger, hipper HIMSS?

Younger and hipper, maybe – because the entire point of labeling something “2.0” is to stick out your tongue at 1.0, at your uncool parents in stretchy jeans and Velcro shoes who, after decades of earnest hard work, still couldn’t figure out how to computerize most of the US health care system. “2.0” screams delineation, divergence, bye-bye. And there seem to be as many ways of delineating “then from now” as there are smart people, of all ages, putting serious work into solving health care’s plethora of problems with 2.0-associated information technologies, services and tools.

A good example is Phil Marshall of WebMD, who happened to be sitting next to me on the airplane from Portland to San Francisco en route to the conference. “1.0 was passive information,” he says, “2.0 engages the patient.” Then he rattles off a long list of application and service types that did not exist in the real world, let alone in health care, a few years ago.

A technologist would say precisely the same thing, if in the language of development languages and architectures that enable the same connectivity or interactivity. A business strategist would also say the same thing, albeit in the language of sustainable revenue models finally emerging in the 2.0 world, after years of snappy slides and wishful thinking. (Note to newcomers: perennial fundraising for ventures that work perfectly in PowerPoint are not sustainable revenue models.)

But essentially Phil is spot-on: “health 2.0” means that the patient gets to talk back. What the patient wants and needs finally matter. And this belated revolution – from provider autocracy to patient autonomy, from Doctor-as-High-Priest to shared provider/patient decision-making, from bricks ‘n’ mortar medical delivery to cybercare – is bigger, broader, and more profoundly de- and re-stabilizing to health care organizations of all types than anything information technology could ever bring to bear. Technology is the means to an end, despite what decades of technologists have tried to convince the business strategists, who in turn have tried to convince the investment community. And so maybe, finally, the specific technologies associated with health 2.0 are cheap enough and unobtrusive enough to get out of the way, and let all of us focus on the point: what the patient wants and needs.

Yes, for the next two days at Health 2.0, we will be gee-whizzing over a mind-bending array of new applications, web services, platforms, un-platforms, and devices – many of which actually work and are in use today. And of course there will be lots of magic tricks, vaporware, investor-type presentations that hinge on the missing “and then a miracle happens” slide, and of course one demo that will explode, slowly and spectacularly, in the hands of an erstwhile entrepreneur. But we will also see feats of imagination in the hands of able people with their feet in the ground, people building technologies that liberate complex medical data from legacy systems, connect patients with communities and clinical trials, throughput lab test-results from primary care physician to specialist to surgeon and back again; technologies that track outcomes, monitor progress, and send alerts to providers, health plans, coaches and caregivers; and, when it’s all prescribed and delivered – technologies for crashing the reimbursement barricades erected back in the darkest ages of “managed care.” But these technologies are the details of the 2.0 story, not the story itself.

The real story is the belated revolution of “modern” medicine. The countless miracles and monstrosities generated in our lifetimes by modern medicine is a hundred years old right about now, if you date its beginning to the introduction of the first antibiotic. In the late 1980s through the early part of the current decade, commercial managed care’s unleashing of the toxic brew of economic power and engineering process was supposed to be the “2.0-ing” of health care – the long overdue and true modernization of classical modern medicine gone mad with greed, money, inefficiency, and arrogance. That revolution was roundly rejected not just by those targeted for the makeover, i.e., self-serving fee-for-service providers, but by much of American society who, in a 1.0 world, had no say-so about any of it for years.

The “2.0-ing” of our health care system today – the one most obviously associated with technology but driven by so many more economic and cultural factors (e.g, health plan design, economic incentive re-alignment, feminization of the physician workforce, the democratization of information, you name it) – is radically different as a cultural phenomenon. This time, it isn’t the health insurance companies taking on an impervious, fee-for-service system; this time, it’s us, the patients, the people. And thanks in part to managed care and its introduction of often brutal methods for separating patients from their providers, we have all learned – often with our own co-payment dollars – precisely how much we value access, immediacy, shock capacity, flexibility, convenience, and choice.

Once again, this has little to do with technology. People started clamoring for the real health 2.0 revolution long before they became “Facebook friends” with people they couldn’t stand in high school, and still wouldn’t be able to stand if they actually had to see them again every day. I expect that the bizarre and delicious delight that is the Facebook phenomenon will get significant play at this year’s conference, as it shows that notions of community inconceivable only a few years ago are not only possible, and not only fringe, but are as re-defining as the Internet itself in how we inhabit much of our lives. And so too it goes in health care: we are NOT partying like it’s 1999, and thank God for that. Technology and information, rather than money and process, are making the belated and true health 2.0 revolution possible. But unlike the last attempt at health care revolution, which showed up too often dressed in the sheep’s clothing of managed care, this time most of us actually want it.

Thanks to our technology-enabled experiences back in the real world, we seem suddenly to have discovered that we cannot email our physicians. And that we can’t get access to our own medical information. And that we have to find a working fax machine to get a copy of something. Huh? After two decades of smart people scratching their heads “why won’t docs use EMRs? How can we get them to start using computers?” I think we finally found a way: shame. Over the past two years, every physician I have encountered, professionally and socially, who was finally buying and installing their first EMR cited none of the usual homilies (e.g., reimbursement, quality, efficiency, modernization, etc.) for the decision; rather, all reported being embarrassed that it took them so long to get around to it.

Now we’re really not partying like it’s 1999, when even the suggestion to a physician friend that an EMR might worth thinking about would lead to a tantrum or firstfight or worse. Apparently, enough politicians of both stripes have finally made enough speeches about the subject; enough colleagues, administrators, and people at health plans said it enough times; and most importantly, enough patients looked at them funny when they started writing down everything the nurse had written down five minutes earlier, in the same “chart.”

Sometimes, the zeitgeist works just fine; sometimes it works well enough to foment a real health care revolution.

Let the 2.0 show begin!

J.D. Kleinke is a medical economist, author, and health information industry leader. He has been instrumental in the creation of four health care informatics organizations; served on the Boards of several public and privately held health care companies; and served as a health care business columnist for the Wall Street Journal.  A regular contributor to the policy journal, Health Affairs, J.D. is currently the CEO of Mount Tabor, a health care information technology development company founded in 2007 to help Google, Microsoft and its partners build, test and launch systems for the transformation and movement of electronic medical information.

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7 replies »

  1. Czund,
    I understand your outrage. You need to understand that everything in about charges and collections is already the result of many previous “reforms”.
    It is illegal for a doctor or hospital to “charge” a different fee for a given CPT code. Medicare would allege under current law that they were being billed fraudulently higher charges if anyone charged less than they charge Medicare. Therefore, no one gets a break on charges.
    It is not illegal to “accept”less than charged to settle the bill. The feceral looters count on docs, hospitals and others to accept less. (And less and less and less.) Sso an individual can take his or her bill right in and negotiate a better deal.
    Contracts are by CPT code, although bundling is coming back in global charges, though not for ED that I am aware. A contract is a contract. But every one is charged the identical amount. It is a practice brought to you by the ethics specialists in Congress.
    It is further illegal for me to talk to another doc about his contract with a given entity. That would be considered price fixing. The feds have no qualms about reverse price fixing.
    So stay outraged, but direct it in the appropriate direction.

  2. JD, if physicians never got around to installing EMRs, there must be a reason for that. People usually don’t get around to doing things that are perceived as being less important, or not very consequential, like cleaning the garage.
    While the current EMRs out there may provide some soft ROI, particularly when paired with practice management and billing systems, and mostly for large clinics, the solo doc that used paper charts for 20 years is mostly unable to realize a major tangible benefit from the existing EMRs.
    The ability to exchange information and obtain a complete continuity of care record are just promises for the future, not a current possibility. It’s the chicken and the egg. I’m a bit skeptical about “shaming” docs into adopting technology.
    The way I see it Health 2.0, is really about the introduction of consumerism into healthcare, which is something that is currently “administered” to a patient. I agree that this needs to change. However, there is a fine line that should not be crossed. Turning health care into a utilitarian service will take the medical profession down the same path as the education profession followed.
    I don’t believe that healthcare quality will be well served by this approach.

  3. I don’t believe you can simply throw more money at technology and have a solution that works. I heard a great quote that an EMR can help medical practices do bad things really fast. We need effective and meaningful use of technology and health care in general. Without government intervention none of these health care technology companies will ever cooperate because it is not in their best interest to do so. Just like pharma reps won’t give free drug samples to pharmacies (because they’re not the ones writing prescriptions).

  4. “who was finally buying and installing their first EMR cited none of the usual homilies (e.g., reimbursement, quality, efficiency, modernization, etc.) for the decision; rather, all reported being embarrassed that it took them so long to get around to it.”
    This is most likely the overwhelming reason for non-adoption heretofore – not getting around to it.
    The relevant point of course that all the money showered or to be showered through the ARRA on physicians to “encourage” EMR adoption is just one more shoveling of money from the poorer (the average taxpayer) to the richer (the physician) for no good reason.
    Despite the often exorbitant pricing of most EMR systems, the economics have always been positive for adoption by physicians.
    Return on investment can easily approach or exceed 100% per year depending on the system, the competence of implementation and the degree to which users are committed to learning how to effectively use a system.
    Financial or other inducements have no material effect on adoption, so are just one more example of somewhat well-intentioned policy-making that has the not-so-unintentional effect of shifting taxpayer funds to certain vested interests who offer little in return.
    Regarding the 2.0 nonsense, it is the same as the hullabaloo about “cloud computing”, a concept and practice that have been around for many decades, but are latched onto by the software/hardware industry to try to convince the uninitiated to throw away their money on what is hyped as the latest and greatest technological breakthrough.
    Good enough that Dr. Kleinke is critical in his commentary, but why waste time, effort and funds to attend the conference while criticizing the concept and its promotional accoutrements?
    Mr. Holt was taken to task on his 2.0 venture in this weblog a while back by a certain Dmitrii, since disappeared. His criticism of the venture was accurate, but in my humble opinion not worth making, given that Mr. Holt is only trying to make a living at this.

  5. When politicians want to advertise on radio, television or print, they must be given the lowest rate currently being given to another advertiser. Therefore, if a radio station (for example)is giving a “buddy” a $10.00 rate for a :30 second commercial, a politician must be given that same rate.
    Now, hospitals and physicians each negotiate rates with insurance companies for services rendered.
    The lowest rates are Medicaid HMO rates. If a patient presents in the E.R., the insurance company will pay the hospitals a negotiated rate, NO MATTER WHAT SERVICES ARE RENDERED. This includes CT scans, Labs, suturing, setting broken bones, any medications that are given, and includes the ER physician, radiologist interpretations and specialists called in to see the patient.
    The all-inclusive price is between $200.00 and $500.00, depending on the state and the county in that particular state.
    If a patient needs to be admitted, there is a set daily rate, THAT IS ALL-INCLUSIVE, NO MATTER WHAT SERVICES ARE RENDERED.
    That rate is anywhere between $150.00 to $250.00 PER DAY.
    ***This would include (for example) any surgery: Coronary By Pass, Appendectomy, Orthopedic, and on and on and on…
    This information should be made public by the hospital. People without insurance should not be charged any more than the lowest contracted rate the hospital is honoring at the time services are rendered. PERIOD!
    If heathcare in this country were handled in this manner, most of us wouldn’t require insurance to begin with. We could then afford to pay for services as events arose in our lives. A hospital stay wouldn’t be “catastrophic”.
    Health insurance coverage could then be for specific “catastophic” events, like neurosurgery resulting from cancer, auto injuries, or events that require ICU, ventilators, long-term care (for example).
    We shouldn’t need insurance to pay for drugs. Pharmacies should be required to make their contracted rates available to the public. The lowest contracted rate for medications should be available to everyone.
    Insurance drug coverage should be for things like chemotherapies (oral and I.V.), Home I.V. antibiotics.
    And while I’m still on my Soap Box, since drug companies give out samples to physicians, they need to be doling out samples to all pharmacies. There is absolutely no excuse for pharmacies not to give out free samples of a medication if they have a written prescription from a licensed physician! PERIOD!

  6. What is more powerful – the donut and the couch or a health 2.0 dashboard with personalized information? I am wagering the donut and the coach for most individuals who aren’t diagnosed with a specific condition.